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'We need a change of culture'

We need to start talking openly about the culture in healthcare and stress levels among staff.

Campaigns have addressed the problems of poor pay and the impact of staff shortages on care, however there seems to be a reluctance to talk about the anxiety that is currently driving the whole culture in healthcare.

In my personal life I try to maintain physical and mental wellbeing. I try to avoid too much stress and watch out for actions motivated by fear and anxiety. Fear is never a good driving force; it leads to division, cynicism, protectionism and resentment.

Fear is usually blind. A failure to see situations realistically or from the other person’s perspective. Personally I am always looking for a balanced perspective in which I look after myself so that I can reach out to others. I want to make a difference in the world but I know this depends on my own wellbeing. I am aware of my own limitations.

Yet in the workplace I see no balance; no wisdom; little understanding or insight into the pressures on nurses and a whole culture driven by fear and anxiety. Fear of litigation, fear of being hauled in front of the NMC, fear of court cases, and fear of making mistakes.

”How can we genuinely care if we feel constantly under threat?”

When we begin as students, nurses are relentlessly warned to be prepared for the scenario of ‘standing up in court’. Fear takes over and all too often becomes the stronger motivating factor to our practice. We work under a continuous threat.

As nurses tend to go into the profession out of good will and a desire to help people, this threat does not rest easy. Nurses are called to care for strangers. My question is this: how can we genuinely care if we feel constantly under threat?

I consider myself a compassionate person but I can’t do it. I feel too angry and anxious about making mistakes. We are in the business of caring. This blame culture does not create a caring environment. It creates anxiety and defensiveness which can quickly turn to resentment.

The public and management need to understand the impact of these pressures on staff. The public want a caring, well-staffed, well-organised NHS and for that to happen, staff need to feel supported and well cared for.

Essentially, nurses – like everybody else – are equipped to care more for others when they feel cared for themselves.

The public should be involved in the debate. The public have been asked to take more responsibility for their own health and encouraged to use the services sensibly.

They also need an awareness of the stress on nurses and the limitations of the health professions. They need to cultivate an appreciation of the wonderful services we do have.

I have personally found patients and relatives more understanding and less likely to complain if they could see I was trying to help; if I stay human and sensitive to their situations. Increased defensiveness when I am focused on protecting myself can quickly come across as indifferent or dismissive and attract hostility and more complaints.

Fear turns the patient into an enemy, it creates an ’us and them’ scenario. Fear always does. It is divisive, it is dangerous and it builds walls instead of bridges.

We need a change of culture as well as the much-needed extra funding. A culture in which staff are valued, supported and trusted will inevitably lead to better care for patients.

Lucy Calcott a staff nurse currently working in a nursing home for the elderly

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